과민성 대장증후군 간호대학생을 위한 인지행동요법 중재의 효과 = (The) effects of cognitive behavior therapy for nursing college students with irritable bowel syndrome

다국어 초록 (Multilingual Abstract)

Aims
The aims of this study were to develop the program of cognitive behavior therapy for nursing college students with irritable bowel syndrome (IBS) and to evaluate the physical, physiological, and psychosocial effects of this program. This study is expected to provide an insight into self-management by applying cognitive behavior therapy and to result in amelioration of related symptoms and improvement in the quality of life for patients with IBS.
Methods
The Rome III criteria were used in screening for IBS among 673 college students at 4 colleges of city B, and 188 students with IBS were selected. From June, 2012 to October, 2012, seventy-six participants, who agreed to participate in this intervention for cognitive behavior therapy, were enrolled in this randomized control group pretest-posttest designed study. We used the questionnaires for physical, physiological, and psychosocial effects to evaluate the effectiveness of the cognitive behavior therapy at baseline and after 8 and 16 weeks, and compared the effects with 39 patients who were treated by the cognitive behavior therapy against 37 patients who received the general information of this syndrome as the control group. Descriptive statistics, χ2-test, t-test and repeated measures of ANOVA with PASW 18.0 were used in the data analysis.
Results
One hundred eighty eight patients of the 673 nursing college students (27.9%) participated in the screening test were diagnosed with IBS. All participants of this study were female and mean age was 21.6 years old. The subtypes of IBS were 61 mixed type (80.3%), 10 diarrhea-predominant type (13.2%), 3 constipation-predominant type (3.9%), and 2 undifferentiated type (2.6%).
Significant changes over time were found for frequency, distress, and interference of the bowel symptom severity (F=12.94, p<.001; F=12.05, p<.001; F=12.65, p<.001, respectively), visceral sensitivity (F=15.83, p<.001), and low frequency/high frequency (LF/HF) of heart rate variability (F=5.50, p=.005) between the intervention and control groups.
There were significant differences between the two groups in the dysfunctional attitude (F=9.82, p<.001), anxiety and depression (F=12.91, p<.001; F=12.71, p<.001, respectively), stress (F=4.28, p=.019), work and social adjustment (F=4.76, p=.011), and IBS-quality of life (F=16.09, p<.001) over time.
The intervention group (n=39), which was managed with cognitive behavior therapy for 8 weeks, displayed a decrease in bowel symptom severity and visceral sensitivity, and an improvement in the autonomic function after 16 weeks compared to the control group (n=37) which received the general information of this syndrome. Also, they showed a decrease in dysfunctional attitude, anxiety, depression, stress, and improvements in work and social adjustment and IBS-quality of life.
Conclusion
It has found that IBS occurs frequently in nursing college students. The cognitive behavior therapy is effective in physical, physiological, and psychosocial control in patients with IBS. In conclusion, the cognitive behavior therapy for nursing college students with IBS was proved as an effective nursing intervention in physical improvement, physiological amelioration, and psychosocial adjustment and safety of patients with IBS.

목차 (Table of Contents)

• Ⅰ. 서론 1
• 1. 연구의 필요성 1
• 2. 연구의 목적 4
• 3. 용어정의 5
• Ⅱ. 문헌 고찰 7
• 1. 과민성 대장증후군과 간호대학생 7
• 2. 인지행동요법 10
• 3. 과민성 대장증후군 완화를 위한 인지행동요법 14
• 4. 연구의 개념틀 20
• Ⅲ. 연구방법 23
• 1. 연구설계 23
• 2. 연구대상 23
• 3. 인지행동요법 중재 27
• 4. 연구도구 35
• 5. 연구진행 절차 42
• 6. 자료분석 방법 47
• Ⅳ. 연구 결과 48
• 1. 실험군과 대조군의 동질성 검정 48
• 1) 대상자의 인구사회학적 특성과 건강관련 특성 48
• 2) 실험군과 대조군의 신체생리 및 심리사회적 특성 50
• 2. 가설검정 52
• 1) 인지행동요법에 따른 실험군과 대조군의 신체생리적 기능의 변화 52
• 2) 인지행동요법에 따른 실험군과 대조군의 심리사회적 요인의 변화 60
• Ⅴ. 논의 71
• Ⅵ. 결론 및 제언 82
• 참고문헌 84
• 부록 105
• ABSTRACT 149